She first experienced a week of spotting, then cramping. In the ER, the pregnancy hormone HCG was low, so all evidence pointed towards miscarriage. But an ultrasound seemed to show blood accumulating in the abdominal cavity, so maybe a tubal pregnancy after all. A tubal pregnancy can rupture the tube causing life-threatening bleeding as well as severe pain. Her initial blood level was normal and when measured six hours later remained unchanged. Also, no pain with an abdominal exam.Decision point: Proceed immediately with laparoscopy to remove a resumed ectopic pregnancy, or wait, repeating the blood test after several more hours, resorting to surgery only if the blood level drops. We decided on the latter. The blood level did drop a little, not conclusive but enough to proceed. She did in fact have an ectopic pregnancy, and the damaged-beyond-repair tube was easily removed. But there was no active bleeding and not much old blood either, the body's own protective mechanisms having stopped the bleeding and in the process of reabsorbing the loss.
So, was this a needless, costly, and perhaps dangerous surgical intervention, or a wise precautionary move to prevent equally dangerous internal bleeding?
My only reference points for ectopic pregnancies are hearing about my mom's scary experience (she started heavily bleeding while out jogging) and a character in one of my favorite books dying from complications (granted, the story was set in the 1800's)... but I think I would err on the side of wise precautionary move.
ReplyDeletea lot depends on the context: availability of close medical care (e.g., urban v. rural) or ability of patient to immediately respond to worsening conditions. Because of increasingly accurate pregnancy tests and ultrasounds, we are able to detect ectopic pregnancies earlier, when there is less risk. That allows us time to consider options.
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